Acute vs. Precipitated Withdrawal

Withdrawal is syndrome that occurs after a person has built up a physical dependence on a psychoactive substance like alcohol, opioids, or benzodiazepines and significantly cuts back or stops their use. While most people are at least familiar with what withdrawal is, they may not be aware that there are different types of withdrawal.

Our guide will explain the difference between acute, protracted, and precipitated withdrawal, why they occur, and how to get effective addiction treatment for you or a loved one.

What is Withdrawal?

When someone use alcohol or drugs, they interact with the brain’s chemical messengers, disrupting their normal transmission, production, movement, and reabsorption within the central nervous system.

Neurotransmitters, such as dopamine, serotonin, gamma aminobutyric acid (GABA), and norepinephrine, are commonly affected. These neurotransmitters send signals in the brain that serve to regulate moods and emotions, learning and memory, motivation, and movement. Drugs like heroin and prescription painkillers interact with opioid receptors in the brain, and levels of dopamine are elevated as a result. High levels of dopamine create a euphoric rush, or “high.” When the drugs are not present, dopamine levels drop, and it can take some time for them to replenish naturally without the drug.

With repeated use of alcohol or drugs, it can become difficult for the brain to keep up with its natural production and transmission of the mood-regulating naturally occurring chemicals. The brain has now become dependent on drugs to keep it balanced. When the substances are processed out of the body, withdrawal side effects begin.

Common Withdrawal Symptoms

The symptoms of withdrawal typically begin when the drug stops working (or being active) in the bloodstream. This depends on the type of drug and its particular half-life. In general, opioid withdrawal begins within 8-12 hours; benzodiazepine withdrawal in 12-24 hours; and alcohol withdrawal can start in as little as six hours after the last drink.

Types of Withdrawal

There are different kinds of withdrawal. These include: acute, protracted, and precipitated.

Acute Withdrawal

The bulk of the withdrawal side effects are usually contained and most intense during what is called acute withdrawal, which is when symptoms are the most significant. A number of factors will influence the intensity and duration of withdrawal symptoms:

• The type of drug used.
• Length of time using it.
• Method of use
• Co-occurring disorders.
• Environmental and biological influences.
• Other drug or alcohol use (polydrug use)

The Substance Abuse and Mental Health Services Administration (SAMHSA) publishes that acute opioid withdrawal typically lasts 4-10 days; acute alcohol withdrawal is generally 5-7 days; and acute benzodiazepine withdrawal is usually 1-4 weeks.

Protracted Withdrawal

The National Institute on Drug Abuse (NIDA) reports that physical withdrawal symptoms typically let up after several days after stopping a drug that has been used long-term; however, emotional withdrawal symptoms may continue. This is called protracted withdrawal, and it may continue for a few weeks or months after acute withdrawal. It can include sleep difficulties, mood disturbances, and cognitive impairment.

Precipitated Withdrawal

Precipitated withdrawal can be significant and have more have more intense side effects than acute withdrawal. It is like a speeded up and more serious version of acute withdrawal, and it can be life-threatening. Precipitated withdrawal occurs when an antagonist substance is introduced too soon after stopping an agonist drug. When used too soon — before the agonist drug is fully out of the system — antagonist drugs can precipitate withdrawal. Antagonists block the effects of agonists (e.g., heroin).

Antagonists, such as naloxone or naltrexone, can therefore be very helpful when attempting to reverse an overdose as they can flush out the agonist drugs and counteract their effects. They are also often used during addiction treatment and recovery to minimize relapse and promote treatment compliance.

Risks of Withdrawal

Withdrawal always has the potential to be dangerous and even fatal without proper care and attention — especially if a person attempts to detox from drugs or alcohol on their own.

Central nervous system depressant drugs, such as opioids, alcohol, and benzodiazepines, all suppress vital life-sustaining functions like body temperature, heart rate, respiration, and blood pressure. When these drugs are used on a regular basis, the body and brain grow accustomed to their presence and disruption of the system. If they are stopped suddenly, or “cold turkey,” the autonomic functions of the central nervous system can rebound, causing a spike in heart rate, blood pressure, and body temperature.

In addition to being physically troublesome and uncomfortable, acute withdrawal can also be emotionally difficult. Individuals may return to using drugs in order to self-medicate withdrawal symptoms.

Managing Withdrawal

Typically, withdrawal symptoms crop up over a period of a few days, as the National Library of Medicine (NLM) reports that opioid withdrawal has both an early and late acute withdrawal phase. Early symptoms are uncomfortable and can gradually progress in intensity during the late phase.

When withdrawal is managed properly, often through a medical detox program, drugs can be slowly tapered or weaned off over a period of time to mitigate withdrawal. In this way, acute withdrawal symptoms are more aptly managed. Withdrawal symptoms are managed with medications and supportive care as part of a medical detox program that provides around-the-clock treatment and supervision.

Preventing Precipitated Withdrawal

Buprenorphine and combination medications that often contain buprenorphine and naloxone are FDA-approved for the treatment of opioid addiction, as published by SAMHSA.

Buprenorphine is a long-acting partial opioid agonist while naloxone is an antagonist. It is important to wait to administer buprenorphine or combination antagonist medications until after the initial agonist opioid, such as heroin or prescription pain relievers, has completely processed out of the body. Taking these medications too soon can result in precipitated withdrawal. Unlike acute withdrawal, the side effects of precipitated withdrawal can come on all at once and with great intensity. This can be extremely difficult and highly dangerous.

To prevent precipitated withdrawal, it is important for a person to be completely honest with treatment providers about when the last dose of an agonist drug was and also to remain abstinent from these drugs during detox and treatment.

Medical Detox in Lafayette, NJ

If you or someone you love is struggling with addiction to drugs or alcohol it’s important to get help from a qualified addiction treatment center that offers safe medical detox. Medical detox will help manage withdrawal symptoms and make you safe and comfortable as your body adjusts to a substance-free state.

To find out more information about our medical detox or our inpatient rehab in New Jersey, contact our helpful and knowledgeable admissions navigators at . They can answer your questions about what to expect in inpatient rehab, tell you more about our different levels of care, and provide helpful tips to get you ready to start the admissions process. Our navigators can also help you find out about using insurance for rehab or other ways to pay for rehab.